Health maintenance organizations: serving L.A. County; ranked by number of Southern California members.

EXECUTIVE SUMMARY

THE 25 largest HMO plans count a combined 9.6 million members in the Southern California region, defined as Los Angeles, Orange, Ventura, San Bernardino. Riverside, Imperial and San Diego counties. This figure is down slightly from the previous year.

Kaiser Permanente remained the largest provider in the region with 3.3 million members, giving it 38 percent of its membership in Southern California. The provider is unique because it also owns hospital facilities. It operates 11 hospitals and 130 medical offices in the region. L.A. County accounts for nearly half of Kaiser's Southern California membership.

L.A. Care Health Plan is the only non-commercial plan to be included, in order to prevent double counting for government programs. The plan provides coverage for county residents and is the largest public health plan in the United States, with nearly 800,000 members. Membership in the plan is up 4 percent over the previous year.

Long Beach-based Universal Care also saw an increase in membership. The plan reported 190,000 members in filings with the California Department of Managed Care, up 40,000 over the previous year.

No. 3 PacifiCare/Secure Horizons reported a decline of 150,000 members in Southern California, all of which took place outside of L.A. County. The plan reported 1.2 million members in the region, of which 250,000 were located in the county.

THE PACESETTER

KAISER FOUNDATION HEALTH PLAN INC.

KAISER Foundation Health Plan Inc. remains the largest commercial health maintenance organization in Southern California with 3.2 million members.

That's up 162,000 members, or 5 percent, from the previous year.

The enrollment increase in Southern California accounted for more than half of the Oakland-based non-profit health plan's membership increase over the past 12 months.

Kaiser has continued to implement its $4 billion KP HealthConnect initiative. The program brings medical records online for all of its patients, despite criticism that the software's implementation may put some patient's safety at risk if the records can't be accessed. The organization has replaced two chief information officers over the past six months as a result.

Kaiser Permanente Baldwin Hills became one of two offices to fully implement the software when it did so in late 2006. Members and medical providers at the facility have access to their complete health record 24 hours a day.

Kaiser has numerous facilities undergoing major renovations or new construction as required by state law passed after the Northridge Earthquake in 1994. Projects include the West L.A. campus, the L.A. Medical Center, Downey Hospital and Panorama City.

Opened in 1945, the health plan grew out of industrial health care programs for Kaiser steel workers during the 1930s and '40s. Kaiser reported systemwide revenues of $34.4 billion for 2006, up $3.3 billion from 2005.

HEALTH MAINTENANCE ORGANIZATIONS

Serving L.A. Cunty; ranked by number of Southern California members

Rank    HMO (Ranking in 2006)                      Enrollment (1)
        * name                                   (current/year ago)
        * HMO                                   * So. California (2)
        * address                                  * L.A. County
                                                   * companywide

   1    Kaiser Foundation Health Plan Inc.         3,287/3,125.1
        393 E. Walnut St.                         1,531.2/1,498.8
        Pasadena 91188                            8,658.3/8,445.2
   2    Blue Cross of California                  2,000.0 (3) /NA
        21555 Oxnard St.                               NA/NA
        Woodland Hills 91367                           NA/NA
   3    PacifiCare/Secure Horizons                  1,200/1,350
        5995 Plaza Drive                              250/250
        Cypress 90630                               3,100/3,300
   4    Health Net of California                      890/812
        21281 Burbank Blvd.                           381/331
        Woodland Hills 91367                        1,600/1,600
   5    L.A. Care Health Plan (4)                     800/765
        555 W. Fifth St., 29th Floor                  800/765
        Los Angeles 90013                             800/765
   6    Blue Shield of California                    492/499.5
        6701 Center Drive West                      216.5/221.3
        Los Angeles 90045                           772.7/763.4
   7    CIGNA Healthcare of California               413/303.3
        400 N. Brand Blvd.                          170.7/302.3
        Glendale 91203                                9,300/NA
   8    Aetna Health of California Inc.             285.6/200.2
        2625 Shadelands Dr.                            NA/NA
        Walnut Creek 94598                         15,400/14,590
   9    Universal Care Inc.                       190.4/159.7 (3)
        1600 E. Hill St.                               NA/NA
        Long Beach 90755                          190.4/159.7 (3)
  10    Great-West Healthcare of Calif. Inc.          39.8/38
        655 N. Central Ave., Suite 1900               19.7/19
        Glendale 91203                                 54/59

Rank        California           Revenues               PPO
            Affiliates         (in millions)
        (current/year ago)     * companywide
           * hospitals          (2006/2005)
           * physicians        * % spent on
                               medical care

   1          30/30           $34,400/$31,100       Dual Choice
           10,587/9,211             93%
   2          NA/NA                NA/NA                NA
              NA/NA                 NA
   3         323/235             NA/14,000          PacifiCare
          47,000/31,000             85
   4         310/268           10,400/11,900      Health Net Life
          55,000/38,000            84.9            Insurance Co.
   5          85/82             1,011.3/946             N/A
           9,650/9,450              NA
   6         307/279           7,854.2/7,668      Shield Spectrum
          29,262/29,515            83.1              PPO Plan
   7         295/302               NA/NA            Connecticut
          46,693/46,654             NA             General Life
                                                   Insurance Co.
   8         310/270           25,100/22,500     Aetna Open Choice
          43,682/46,182             NA                  PPO
   9          NA/NA                NA/NA               none
              NA/NA                 NA
  10         250/250               NA/NA            Great-West
          26,000/26,000             NA            Healthcare PPO

Rank         Profile                         Structure
        * year established                 * plan model
          * headquarters                     * status
        * enrollment phone               * parent company

   1           1945                            group
             Oakland                        non-profit
          [phone]                 Kaiser Permanente
   2           1986                         contractual
          Thousand Oaks                       profit
          [phone]          WellPoint Health Networks Inc.
   3           1978                         contractual
             Cypress                          profit
          [phone]                 United Healthcare
   4           1979                         contractual
          Woodland Hills                      profit
          [phone]                  Health Net Inc.
   5           1997                            mixed
           Los Angeles                      non-profit
          [phone]                       same
   6           1990                            mixed
          San Francisco                     non-profit
          [phone]                        NA
   7           1929                         contractual
           Philadelphia                       profit
          [phone]                    Cigna Corp.
   8           1981                            mixed
         Hartford, Conn.                      profit
          [phone]                    Aetna Inc.
   9           1983                            mixed
           Signal Hill                        profit
          [phone]                        NA
  10           1994                         contractual
             Glendale                         profit
          [phone]      Great-West Life & Annuity Insurance Co.

Rank    Top Local Executive
        * name
        * Top Local Executive
        * title
        * phone

   1    Dr. Benjamin K. Chu
        president, So. Cal. region
        [phone]
   2    Brian A. Sassi
        president
        [phone]
   3    David Hansen
        ceo
        [phone]
   4    Stephen Lynch
        president, Reg. Health Plans
        [phone]
   5    Howard A. Kahn
        ceo
        [phone]
   6    Jim Elliot
        v.p., Southern California
        [phone]
   7    Christopher De Rosa
        president, gen. manager
        [phone]
   8    Curtis Terry
        reg. head, Health Care Deliv.
        [phone]
   9    Jay B. Davis
        president
        [phone]
  10    Susan Hallett
        regional president
        [phone]

NA--Not Available

Note: The information on this list was provided by representatives of
the health plans themselves and the California Department of Managed
Care. HMOs are ranked by current commercial enrollment. L.A. Care
Health Plan was the only non-commercial health plan to be included in
order to prevent double counting of enrollment in government programs.

To the best of our knowledge, this information is accurate as of press
time. While every effort is made to ensure the accuracy and
thoroughness of the list, omissions and typographical errors sometimes
occur. Please send corrections or additions on company letterhead to
the Research Department, Los Angeles Business Journal, 5700 Wilshire
Blvd., Suite 170, Los Angeles 90036. [c] 2007 Los Angeles Business
Journal. This list may not be reprinted in whole or in part without
prior written permission from the editor. Reprints are available from
Wright's Reprints, [phone].

(1) In thousands.

(2) Southern California is defined as Los Angeles, Orange, Ventura, San
Bernardino, Riverside, Imperial and San Diego counties.

(3) Business Journal estimate.

(4) Enrollment figures for Medi-Cal, Healthy Families, California Kids,
Healthy Kids and In-Home Supportive Services.

Researched by David Nusbaum